Background: Single parathyroid adenoma is the commonest cause of primary hyperparathyroidism. Localization of the affected gland preoperatively is a critical step in management. Surgery is considered as the main line of treatment for single parathyroid adenoma. Focused technique for parathyroid excision was found by many researchers to have a good success rate even without intraoperative parathyroid hormone measurement.  
Objective: The aim of this study was to assess the feasibility, safety, and adequacy of focused parathyroidectomy via an open lateral approach using preoperative positive Sestamibi (MIBI) scan and/or ultrasound without utilizing any intraoperative aiding tools. 
Methods: A case-series prospective analysis of focused open parathyroidectomy for 20 patients presented to the department of surgery or referred from the orthopedic department between October 2012 and January 2015 at the Faculty of Medicine, Al-Azhar University, Cairo, Egypt, diagnosed as sporadic hyperparathyroidism with either positive MIBI scan or ultrasound were done. Normalization of the postoperative levels of serum calcium and PTH was considered as a marker of success.  Data entry and analysis were done using the IBM-SPSS version 22.
Results: In this study, focused minimal access parathyroidectomy was successful in 95% with no major surgical complications, i.e., recurrent laryngeal nerve palsy or permanent hypoparathyroidism. The patient's mean age was 46.5±12 years. The preoperative serum calcium level ranged from 8.8 to 15.2 mg/dL. The parathyroid hormone level was elevated ranging from 123-2000 pg/mL. In 90% of the cases, serum levels of alkaline phosphatase were elevated, while serum phosphorus was low with range 1.5-4.7 mg/dL. The left inferior parathyroid gland was the most commonly involved gland (40%). Using ultrasound and Sestamibi scan for preoperative localization was accurate in 75% and 90%, respectively. When both techniques were combined localization accuracy increased to 95%. 
Conclusion: Our study has shown that focused parathyroidectomy is considered as a good option for single gland disease even if there are no available intraoperative helping aids, provided that good patient selection is undertaken.


Keywords: Parathyroidectomy, Focused parathyroidectomy, Single adenoma hyperparathyroidism, Parathyroid hormone


» HTML Fulltext    » PDF Fulltext    » doi: 10.19082/6974

Current Issue

In the second issue of the journal Electronic Physician for 2019, we have several papers including four Randomized Controlled Trials, a model development study, a case report, an editorial, a letter to editor (LTE), and several original research including two studies with qualitative approach. Authors of this issue are from nine countries: Iran, The Netherlands, Sweden, Italy, India, Thailand, Saudi Arabia, United Arab Emirates (UAE), and Jordan. Read more...


The 6th World Conference on Research Integrity (WCRI) is to be held on June 2-5, 2019 in Hong Kong.

The WCRI is the largest and most significant international conference on research integrity. Since the first conference in Lisbon in 2007, it has given researchers, teachers, funding agencies, government officials, journal editors, senior administrators, and research students opportunities to share experiences and to discuss and promote integrity in research. Read more:


TDR Clinical Research and Development Fellowships

Call for applications

Deadline for submission: 7 March 2019, 16:00 (GMT)

TDR provides fellowships for early- to mid-career researchers and clinical trial staff (e.g. clinicians, pharmacists, medical statisticians, data managers, other health researchers) in low- and middle-income countries (LMICs) to learn how to conduct clinical trials. Read more:

Meta-Analysis Workshops in New York, USA, and London, UK, in April and May 2019

Don't miss this exceptional opportunity to learn how to perform and report a Meta-analysis correctly. Two Meta-analysis workshops are organized in April and May 2019 by Dr. Michael Borenstein in New York, USA (April 08-10, 2019) and London, UK (May 27-29).

About the Instructor

Dr. Michael Borenstein, one of the authors of Introduction to Meta-Analysis, is widely recognized for his ability to make statistical concepts accessible to researchers as well as to statisticians. He has lectured widely on meta-analysis, including at the NIH, CDC, and FDA. Read more: